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终末期肾衰竭中的种族和民族差异——非裔美国人的生存悖论

Racial and ethnic disparities in end-stage kidney failure-survival paradoxes in African-Americans.

作者信息

Agodoa Lawrence, Eggers Paul

机构信息

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.

出版信息

Semin Dial. 2007 Nov-Dec;20(6):577-85. doi: 10.1111/j.1525-139X.2007.00350.x.

Abstract

The risk of death is nearly 45% lower in African-Americans than Caucasians undergoing chronic hemodialysis. In light of the higher mortality rate in African-Americans in the general US population, this paradox requires explanation and further investigation. Factors that may contribute to this survival advantage include a younger age at which African-Americans arrive at end-stage renal disease (ESRD) and the slightly higher body mass index. On the other hand, factors, such as lower residual renal function, lower mean hemoglobin and hematocrit, increased prevalence of hypertension, a higher prevalence of catheter use for initial dialysis, and generally lower dose of dialysis should put African-Americans on dialysis at a higher risk of death. This survival advantage seems to be completely annulled with a successful renal transplant. Finally, it should be noted that ESRD carries with it a very high mortality rate in all racial and ethnic groups. A successful renal transplant improves but does not restore the expected remaining life times. Therefore, aggressive approach is required in investigating the factors that confer such high mortality risk on ESRD patients.

摘要

接受慢性血液透析的非裔美国人的死亡风险比白种人低近45%。鉴于在美国普通人群中非裔美国人的死亡率较高,这种矛盾现象需要解释并进一步研究。可能导致这种生存优势的因素包括非裔美国人进入终末期肾病(ESRD)时年龄较轻以及体重指数略高。另一方面,诸如残余肾功能较低、平均血红蛋白和血细胞比容较低、高血压患病率增加、初次透析时使用导管的患病率较高以及透析剂量普遍较低等因素,应使接受透析的非裔美国人面临更高的死亡风险。成功进行肾移植后,这种生存优势似乎完全消失。最后,应该指出的是,ESRD在所有种族和族裔群体中都伴随着非常高的死亡率。成功的肾移植可改善但无法恢复预期的剩余寿命。因此,需要积极研究导致ESRD患者面临如此高死亡风险的因素。

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